Objective To observe the effect of Shenfu injection on lung injury caused by hemor-rhagic shock(HS)in rats and explore the related potential mechanism.Methods Thirty-six SPF healthy male SD rats,aged 16-17 weeks,weighing 400-600 g,were randomly divided into three groups:sham op-eration group(group SH),HS group(group HS),and Shenfu injection group(group SF),12 rats in each group.In group SH,only the right femoral vein and femoral artery were separated after anesthesia,and ve-nous catheterization was not performed.HS model was established in groups SF and HS.In group HS,liquid resuscitation was performed through an intravenous catheter,and the resuscitation fluid consisted of the auto-blood lost and the compound sodium chloride injection equivalent to 1.5 times the blood loss and 10 ml/kg normal saline.In group SF,the resuscitation fluid consisted of the lost autoblood and the compound sodium chloride injection equivalent to 1.5 times the blood loss and Shenfu injection 10 ml/kg.The whole perfusion time was about 60 minutes.Six rats in the three groups were randomly anesthetized 24 and 48 hours after op-eration.The wet/dry weight ratio(W/D)of lung tissues was detected.The concentrations of interleukin-6(IL-6),IL-17,IL-10,and transforming growth factor-β(TGF-β)were detected by ELISA,the mRNA ex-pression of retinoic acid-related orphan nuclear receptor γt(RORγt),transcription factor forkhead box pro-tein 3(Foxp3),and hypoxia-inducible factor-1α(HIF-1α)in lung tissues were detected by PCR.The pro-tein contents of RORγt,Foxp3,HIF-1α,aquaporin 1(AQP1),and AQP5 in lung tissue were detected by Western blot.Pathological changesunder HE staining light microscope and lung injury scores were observed.Results Compared with 24 hours after operation,W/D,the concentrations of IL-6 and IL-17,mRNA ex-pression and protein content of RORγt and HIF-1α,and lung injury score were significantly decreased(P＜0.05),the concentrations of IL-10,and TGF-β,Foxp3 mRNA expression and protein content,and AQP1 protein content were significantly increased in group SF 48 hours after operation(P＜0.05).Compared with group SH,W/D,the concentrations of IL-6,IL-17,IL-10,and TGF-β,mRNA expression and protein content of RORγt,Foxp 3,and HIF-1α,and lung injury score were significantly increased(P＜0.05),AQP1 and AQP5 protein contents were significantly decreased in groups HS and SF 24 and 48 hours after operation(P＜0.05),and alveolar structure was damaged under light microscope and alveolar interstitium was filled with a large amount of edematous fluid,during which a large number of inflammatory cells infiltra-ted.Compared with group HS,W/D,the concentrations of IL-6 and IL-17,mRNA expression and protein content of RORγt and HIF-1α,and lung injury score were significantly decreased(P＜0.05),the concen-trations of IL-10 and TGF-β,Foxp3 mRNA expression and protein content,AQP1 and AQP5 protein con-tents were significantly increased in group SF 24 and 48 hours after surgery(P＜0.05),and the alveolar structure was improved under light microscope,and edema was reduced,and the number of inflammatory cells was reduced.Conclusion Shenfu injection can regulate the balance between pro-inflammatory factors IL-6 and IL-17,and anti-inflammatory factors IL-10 and TGF-β,increase the protein content of AQP1 and AQP5 in lung tissue,and decrease the W/D and injury score in lung tissue,thus alleviating lung injury in HS rats.The mechanism may be related to the regulation of HIF-1α-RORγt/Foxp3 balance.

Objective This study aimed to explore the differences in global and local brain network topological properties between deficient pattern(DP)and excess pattern(EP)of mild vascular cognitive impairment caused by subcortical small vessel disease based on graph theory network.Methods Patients were recruited prospectively and were classified with DP and EP subtype.The global small-world topological attributes and local nodes were calculated for the comparison of DP,EP,and healthy controls(CN)using the GRETNA platform.Results The three groups all had small-world attributes,but only the patients in EP had a significantly lower small world attribute δ in the range of 0.05-0.26 than the control group(P<0.05).The node efficiency and node strength indicators of multiple brain region were able to significantly distinguish the DP group from the EP group.However,there was no positive brain region in the node efficiency of the DP patients(P>0.05),and only a few brain regions showed increased node strength efficiency(P<0.05).Conclusion The results indicate that the syndrome of DP and EP have significantly different neuroimaging phenotypes,providing a basis for further research of biological classification based on Chinese Medicine syndromes.

Objective:To study the clinical and immunological features of two case of rare antisynthetase syndrome (ASS), so as to improve the level of diagnosis and treatment.Methods:Two cases with rare antisynthetase syndrome admitted to the First Affiliated Hospital of Zhengzhou University from July 2020 to August 2022 were collected.Results:The two rare ASS were anti-Zo antibody and anti-Ha antibody positive patients, both of which had interstitial lung disease (ILD) as the main clinical manifestation and positive anti-Ro52 antibody. Two rare antisynthetase autoantibodies manifested cytoplasmic ANA indirect immunofluorescence (IIF) staining pattern, but it is different from the cytoplasmic dense speckled pattern of several common ASS antibodies. After treatment with glucocorticoids and immunosuppressants, case 1 died of respiratory failure due to a long course of disease and late diagnosis, the lung lesions of case 2 improved significantly.Conclusion:When encountering the cytoplasmic ANA fluorescent pattern in ILD patients, especially with anti-Ro52 antibody, it is necessary to screen more myositis specific antibodies to rule out the possibility of rare ASS.

Objective:To investigate the impact of sarcopenia on the short-term outcomes and long-term prognosis in cervical cancer patients undergoing concurrent chemoradiotherapy (CCRT).Methods:A total of 410 cervical cancer patients who received CCRT in Henan Provincial People′s Hospital between January 2017 and December 2021 were prospectively enrolled in this study. They were divided into the sarcopenia and non-sarcopenia groups based on the body muscle content measured using bioelectrical impedance analysis. Short-term outcomes were assessed according to the Response Evaluation Criteria in Solid Tumors (RECIST), and acute adverse reactions were assessed based on the toxicity criteria of the Radiation Therapy Oncology Group (RTOG). CCRT termination or prolonged treatment associated with various acute adverse reactions were recorded. All patients were followed up with overall survival (OS) and progression-free survival (PFS) as endpoints. Finally, the survival rate was estimated and the association between sarcopenia and PFS was analyzed.Results:Among the patients, 152 (37.1%) had sarcopenia. Compared to the non-sarcopenia group, the sarcopenia group exhibited higher incidences of grade 2 or above acute adverse reactions in the lower gastrointestinal and hematological systems, CCRT termination, or prolonged treatment. In the non-sarcopenia group, 27 deaths were recorded, with an OS of 30 (18-36) months, a 3-year OS rate of 88.7%, and a 5-year OS rate of 85.6%. In the sarcopenia group, 23 deaths were found, with an OS of 24 (15-33) months, a 3-year OS rate of 83.8%, and a 5-year OS rate of 77.7%. There was no significant difference in survival curves between both groups ( P > 0.05). In the non-sarcopenia group, 52 cases of recurrence were recorded, with a PFS of 21 (12-33) months, a 3-year PFS rate of 77.9%, and a 5-year PFS rate of 71.0%. In the sarcopenia group, 41 cases of recurrence were found, with a PFS of 15 (10.5-24) months, a 3-year PFS rate of 69.0%, and a 5-year PFS rate of 56.5%. There was a significant difference in the PFS curves between both groups ( χ2 = 5.89, P = 0.015). Multivariate Cox regression analysis identified sarcopenia as an independent risk factor for PFS ( χ2 =4.33, P = 0.037). Conclusions:Sarcopenia increases the risks of acute adverse reactions and long-term recurrence in cervical cancer patients undergoing CCRT.

Objective To evaluate the effect of acupuncture(manual acupuncture,electroacu-puncture)on prevention and treatment of nausea and vomiting after general anesthesia.Methods By searching CNKI,VIP,China Biomedical Literature Database,Wanfang Medical,Embase,PubMed,Co-chrane Clinical Trial Registry,randomized controlled trial(RCT)on acupuncture combined with antiemetics for the prevention and treatment of nausea and vomiting after general anesthesia were performed.The retrieval period was from the establishment of the database to September 2022.RevMan 5.3 was used for statistical analysis.Results Fifteen studies involving 1 493 patients were included.There were 741 patients in the antiemetic group and 752 patients in the acupuncture combined antiemetic group.The incidence of postoperative nausea in the acupuncture combined with antiemetics group was significantly lower than that in the simple antiemetics group(OR=0.43,95％CI 0.34-0.54,P＜0.001).The incidence of postopera-tive vomiting in the acupuncture combined with antiemetics group was significantly lower than that in the simple antiemetics group(OR=0.55,95％CI 0.45-0.66,P＜0.001).Conclusion The incidence of postoperative nausea and vomiting was lower in patients treated with acupuncture(manual acupuncture,electroacupuncture)combined with antiemetics than with antiemetics alone.

ObjectiveTo systematically evaluate the efficacy and safety of Tianmeng Oral Liquid in the treatment of hyperprolactinemia caused by antipsychotics in female patients with schizophrenia， and to provide references for intervention of antipsychotic-induced hyperprolactinemia patients. MethodsEnglish databases （PubMed， Cochrane Library， PsycINFO and Embase） and Chinese databases （CNKI and Wanfang） were systematically searched， with a search time frame of the period from database creation to September 16， 2022. Randomized controlled studies （RCTs） on adjunctive Tianmeng Oral Liquid in the treatment of hyperprolactinemia caused by antipsychotics in female patients with schizophrenia were included. Three investigators independently screened the literatures and extracted data according to PICOS principles and evaluated the quality of including literatures， and the Meta-analysis was performed by using RevMan 5.3. ResultsA total of 3 articles including 256 female schizophrenic patients with hyperprolactinemia were included. Meta-analysis results showed that at the treatment endpoint， the improvement of hyperprolactinemia symptoms reported a significant superiority of the intervention group than the control group （RR=1.73， 95% CI： 1.07~2.79， P˂0.05）. Similarly， the significant superiority of the intervention group than the control group were also found in reducing serum prolactin levels （WMD=-55.17， 95% CI： -68.16~-42.18， P<0.01） and Positive and Negative Syndrome Scale （PANSS） total scores were lower in the intervention group than in the control group （WMD=-7.36， 95% CI： -8.94~-5.77， P<0.01）. ConclusionTianmeng Oral Liquid may help improve clinical efficacy and reduce serum prolactin levels in female schizophrenia patients with hyperprolactinemia. It may improve psychiatric symptoms in female patients with schizophrenia.

Hepatic artery reconstruction is one of the key procedures in liver transplantation. Accidental dissection of the hepatic artery to be reconstructed caused by donor and recipient factors or surgical factors will disrupt the surgical plan, increase the difficulty of arterial reconstruction, significantly prolong the operation time, increase the risk of postoperative arterial stenosis and thrombosis and probably lead to acute allograft failure, which requires emergency surgical interventions or even secondary liver transplantation. Understanding of how to avoid dissection of the artery to be anastomosed during liver transplantation and corresponding treatment will contribute to preventing the incidence of artery-related complications during liver transplantation and improving clinical prognosis of liver transplant recipients. In this article, the causes, prevention and treatment of hepatic artery dissection and hepatic artery reconstruction in donors and recipients during liver transplantation were illustrated.

Objective:To investigate the causes and prognosis of salvage cholecystectomy for relapsing cholecystolithiasis after gallbladder-preserving gall stones removal surgery.Methods:From Jul 2015 to Dec 2019, 24 referral patients with gallstone recurrence after gallbladder-preserving cholelithotomy surgery received salvage cholecystectomy. The clinical data was analyzed to explore the causes for re-operation and the prognosis.Results:Twenty-two cases had definite gallstone recurrence, among them 19 cases were symptomatic, 2 cases were operated on suspected gallbladder tumor and common bile duct stones induced acute cholangitis. Laparoscopic cholecystectomy was successfully performed in 23 cases and 1 case was converted to open surgery. No severe complication were observed in all the patients.Conclusions:Symptomatic gallstone recurrence is the most common causes of salvage cholecystectomy after gallbladder-preserving cholelithotomy. Laparoscopic surgery procedure is still highly successful.

Taking case discussion of clinical treatment options of primary liver cancer during clinical internship as an example, the course design of basic elements of case-based learning (CBL) was discussed. The purpose of clinical practice is to cultivate the clinical thinking ability of "selecting the best one from multiple treatment options", which is suitable for taking CBL teaching method. The design of CBL course includes 8 elements: teaching object, purpose, objectives, course content, implementation plan, key points for assessment, course evaluation and reference materials. The core points of the design of CBL course are that: ①The teaching objectives include knowledge, ability and professionalism; ②The course content should includes the training of decision-making organizations and clinical thinking ability of selecting the best one from multiple treatment options; ③The general CBL teaching procedure can be adopted in the implementation of the scheme that focuses on the decision-making issues defined in each decision-making step. The teaching practice of CBL on primary liver cancer cases discussion shows the basic design of CBL course is universal, which is helpful for teachers to design and implement CBL course on clinical treatment options.

Objective:To study the clinical features of infective endocarditis (IE) with positive anti-neutrophil cytoplasmic antibodies (ANCA) in order to improve the level of diagnosis and treatment.Methods:Eighteen IE cases with positive ANCA admitted to the First Affiliated Hospital of Zhengzhou University from June 2016 to July 2021 were collected. The demographic information, clinical symptom, laboratory tests, imaging examinations, treatment and clinical outcomes were analyzed retrospectively. Statistical program for social sciences (SPSS) 20.0 statistical software was used for analysis. Enumeration data were expressed as the number of cases and percentage (%), and measurement data were expressed as Mean± SD. Results:Twelve cases were male and 6 cases were female, with an average age of (50±16) years. Sixteen patients had positive PR3-ANCA, in which 2 cases had positive myeloperoxidase (MPO)-ANCA. The major clinical manifestations included fever (88.9%, 16/18), anemia (72.2%, 13/18), splenomegaly (44.4%, 8/18), cardiac murmur (33.3%, 6/18), arthralgia (22.2%, 4/18), liver damage (22.2%, 4/18), thromboembolic events (16.7%, 3/18), Osler's node (11.1%, 2/18) and renal dysfunction (11.1%, 2/18). Higher C-reactive protein (CRP), erythrocyte sedimentation (ESR) and procalcitionin (PCT) were detected in 83.3% (15/18) patients. The positive rate of blood culture was 50.0%(9/18) and streptococcus was the most common pathogen (77.8%, 7/9). Echocardiograms of all patients showed abnormal vegetation, most commonly involving the mitral valve (66.7%, 12/18) and aortic valve (33.3%, 6/18). Two patients were misdiagnosed as ANCA associated vasculitis (AAV), but the other one was diagnosed as AAV with IE as the first manifestation. Except for one case who died of multiple organ failure, all cases reached clinical recovery after surgery and antibiotic therapy.Conclusion:IE patients with positive ANCA may present with the clinical manifestations similar to AAV. We should highly alert to avoid misdiagnosis and treatment.